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ISTPA University Membership Enrollment

Fill out University Membership Enrollment Form and Membership Agreement.

Print and sign University Membership Enrollment Form and Membership Agreement. Send signed University Membership Enrollment Form and Membership Agreement to:

The annual university membership dues are $1,000 USD per year. Upon application approval you will be invoiced (prorated) for the 1st year university membership dues and upon payment you will be notified by email that your membership has been activated. This email notification will provide instructions to access your online membership account. Please allow for 2-3 weeks for processing of the membership enrollment requests.

If for any reason your application for membership is declined you will be contacted and if unresolved your check will be returned promptly.

Fill out university membership enrollment form.

* REQUIRED FIELDS

* University Name:

Department/School Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

* Main Phone:

Ext:

Main Fax:

URL:

Year Your University Established:

Public/Private:

Public

Private

Annual university membership dues:

University

The annual university membership dues are $1,000 USD per year.

$1000 USD per year

Membership Primary/Administrative Contact

* First Name:

* Last Name:

Title:

* Phone:

Ext:

Fax:

* Email:

Membership Account Username
(select a username 6-20 alpha numeric characters A-Z, a-z, 0-9 no special characters allowed)

* Username:

Membership Account Password
(select a password 6-12 alpha numeric characters A-Z, a-z, 0-9 no special characters allowed)

* Password:

* Retype Password:

* Membership Billing Contact

Same as above

First Name:

Last Name:

Title:

Phone:

Ext:

Fax:

Email:

Billing Address

University Name:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip or Postal Code:

* Country:

Additional university representative(s) that will be included in the ISTPA membership directory

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

First Name:

Last Name:

Phone:

Email:

For adding additional university representatives contact the ISTPA membership administrator.

Print, sign and send University Membership Enrollment Form and Membership Agreement.

ISTPA
By:	_________________________________	By:	_________________________________
ISTPA Officer		Title:	_________________________________
Date:	_________________________________	Date:	_________________________________

Send signed University Membership Enrollment Form and Membership Agreement to:

Upon application approval you will be sent, by US Mail, an ISTPA counter signed agreement with an invoice, (prorated) for the applicable 1st year membership dues. Upon payment you will be sent an email notification with instructions to access your online membership account. Please allow for 2-3 weeks for processing of the membership enrollment requests.

If any issues arise with regard to membership enrollment or payment of dues you will be contacted by the ISTPA. If you have any questions regarding membership enrollment or the ISTPA please contact:

John Sabo
President
(703) 708-3037

Kevin O'Neil
Executive Director
(858) 793-8100

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